Article (Scientific journals)
EACVI recommendations on cardiovascular imaging for the detection of embolic sources: endorsed by the Canadian Society of Echocardiography.
Cohen, Ariel; Donal, Erwan; Delgado, Victoria et al.
2021In European Heart Journal. Cardiovascular Imaging
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Keywords :
cardiovascular imaging; computed tomography; cryptogenic stroke; echocardiography; embolic stroke; guidelines; ischaemic stroke; magnetic resonance imaging; stroke
Abstract :
[en] Cardioaortic embolism to the brain accounts for approximately 15-30% of ischaemic strokes and is often referred to as 'cardioembolic stroke'. One-quarter of patients have more than one cardiac source of embolism and 15% have significant cerebrovascular atherosclerosis. After a careful work-up, up to 30% of ischaemic strokes remain 'cryptogenic', recently redefined as 'embolic strokes of undetermined source'. The diagnosis of cardioembolic stroke remains difficult because a potential cardiac source of embolism does not establish the stroke mechanism. The role of cardiac imaging-transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE), cardiac computed tomography (CT), and magnetic resonance imaging (MRI)-in the diagnosis of potential cardiac sources of embolism, and for therapeutic guidance, is reviewed in these recommendations. Contrast TTE/TOE is highly accurate for detecting left atrial appendage thrombosis in patients with atrial fibrillation, valvular and prosthesis vegetations and thrombosis, aortic arch atheroma, patent foramen ovale, atrial septal defect, and intracardiac tumours. Both CT and MRI are highly accurate for detecting cavity thrombosis, intracardiac tumours, and valvular prosthesis thrombosis. Thus, CT and cardiac magnetic resonance should be considered in addition to TTE and TOE in the detection of a cardiac source of embolism. We propose a diagnostic algorithm where vascular imaging and contrast TTE/TOE are considered the first-line tool in the search for a cardiac source of embolism. CT and MRI are considered as alternative and complementary tools, and their indications are described on a case-by-case approach.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Cohen, Ariel
Donal, Erwan
Delgado, Victoria
Pepi, Mauro
Tsang, Teresa
Gerber, Bernhard
Soulat-Dufour, Laurie
Habib, Gilbert
Lancellotti, Patrizio  ;  Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
Evangelista, Arturo
Cujec, Bibiana
Fine, Nowell
Andrade, Maria Joao
SPRYNGER, Muriel ;  Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Angéiologie
Dweck, Marc
Edvardsen, Thor
Popescu, Bogdan A.
More authors (7 more) Less
Language :
English
Title :
EACVI recommendations on cardiovascular imaging for the detection of embolic sources: endorsed by the Canadian Society of Echocardiography.
Publication date :
2021
Journal title :
European Heart Journal. Cardiovascular Imaging
ISSN :
2047-2404
eISSN :
2047-2412
Publisher :
Oxford University Press, United Kingdom
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.
Available on ORBi :
since 02 September 2021

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